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Current Practice in Immunosuppression in Pediatric Liver Transplantation
Rodrigo Vincenzi1, Eduardo A Fonseca1, Karina M O Roda1
1Liver Transplant Department, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.
Current Pharmaceutical Design
|June 15, 2020
Summary
Pediatric liver transplantation (LT) survival has improved, but managing immunosuppression is complex due to unique challenges like growth issues and adherence problems in children. This article reviews current strategies for pediatric LT immunosuppression.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Transplantation Immunology
- Pediatric Surgery
Background:
- Pediatric liver transplantation (LT) has seen significant advancements, leading to improved long-term survival for young patients.
- Increased survival exposes pediatric recipients to prolonged immunosuppression, raising concerns about metabolic, infectious, neoplastic, and organ-specific toxicities.
- Children present unique challenges in immunosuppression management, including growth disturbances and adherence issues during adolescence.
Purpose of the Study:
- To review current immunosuppressive strategies specifically tailored for pediatric liver transplant recipients.
- To address the complexities of balancing adequate immunosuppression and minimizing long-term side effects in children.
- To highlight challenges unique to pediatric LT, such as growth and adolescent nonadherence.
Main Methods:
- Review of current literature on pediatric liver transplantation and immunosuppression.
- Analysis of factors influencing immunosuppressive therapy in pediatric recipients.
- Discussion of common complications and management strategies.
Main Results:
- Improved graft and patient survival in pediatric LT is attributed to advances in graft selection, surgical techniques, live donation, and postoperative care.
- Pediatric recipients face distinct immunosuppression-related complications, including metabolic disturbances, infections, malignancies, nephrotoxicity, and neurotoxicity.
- Optimizing immunosuppression in children is more challenging than in adults due to individual variability, growth considerations, and adherence issues.
Conclusions:
- Current immunosuppressive strategies aim to balance efficacy and safety in pediatric liver transplant recipients.
- Addressing pediatric-specific challenges like growth and adherence is crucial for long-term outcomes.
- Further research is needed to refine immunosuppressive protocols for pediatric LT to minimize long-term morbidity.
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